Diabetes & Metabolic Syndrome-Clinical Research & Reviews最新文献_第8页

The burden of cardiovascular disease attributable to high fasting plasma glucose：Findings from the global burden of disease study 2019 空腹血浆葡萄糖过高导致的心血管疾病负担：2019 年全球疾病负担研究发现

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103025

Xin-Jiang Dong , Xiao-Qi Zhang , Bei-Bei Wang , Fei-Fei Hou , Yang Jiao

Aim

High fasting plasma glucose (HFPG) is a key risk factor for cardiovascular disease (CVD). Few studies have evaluated the CVD burden attributable to HFPG globally. It is urgent to investigate the current epidemiological pattern and past trends of CVD attributable to HFPG.

Methods

We used the Global Burden of Disease Study (GBD) 2019 to describe the CVD burden attributable to HFPG in 2019 and evaluate temporal trends between 1990 and 2019.

Results

Global Disability-Adjusted Life Years (DALYs) cases and death cases of HFPG-related CVD were approximately 72,591,163 and 3,763,298 in 2019, with an increase of 107.4 % and 114.6 % compared with 1990, respectively. Despite the increases, the age-standardized DALYs rate (ASDAR) and age-standardized death rate (ASDR) of HFPG-related CVD contributed to 895.2 per 100,000 people and 48.4 per 100,000 people in 2019, with an estimated annual percentage change (EAPC) of −0.22 and −0.31, respectively, from 1990. The highest ASDAR and ASDR of HFPG-related CVD were in 2019 observed in the low-middle SDI (Socio‐demographic Index) and middle-SDI regions. Low SDI and some low-middle SDI regions showed an increase in ASDAR and ASDR of HFPG-related CVD from 1990 to 2019. Males are more affected by HFPG-related CVD than females across all years. The CVD burden attributable to HFPG in the elderly are higher than those in the young in 2019. The main causes of the global CVD burden attributable to HFPG in 2019 were ischemic heart disease, stroke, and peripheral arterial disease.

Conclusion

The CVD burden attributable to HFPG remains a serious public health challenge threatening human health worldwide. It is necessary to develop more targeted and specific strategies to reduce CVD burden attributable to HFPG, especially in males, elderly, and lower SDI regions.

目的高空腹血浆葡萄糖（HFPG）是心血管疾病（CVD）的一个关键风险因素。很少有研究对全球因空腹血浆葡萄糖过高而导致的心血管疾病负担进行评估。方法我们利用2019年全球疾病负担研究（GBD）描述了2019年HFPG导致的心血管疾病负担，并评估了1990年至2019年之间的时间趋势。结果2019年全球HFPG相关心血管疾病的残疾调整生命年（DALYs）病例和死亡病例分别约为72,591,163例和3,763,298例，与1990年相比分别增加了107.4%和114.6%。尽管有所增长，但2019年高危人群相关心血管疾病的年龄标准化残疾调整寿命年率（ASDAR）和年龄标准化死亡率（ASDR）分别为每10万人895.2例和每10万人48.4例，与1990年相比，估计年百分比变化（EAPC）分别为-0.22和-0.31。2019年，中低SDI（社会人口指数）和中SDI地区的高脂血症相关心血管疾病的ASDAR和ASDR最高。从 1990 年到 2019 年，低 SDI 和一些中低 SDI 地区的高血脂相关心血管疾病的 ASDAR 和 ASDR 均有所上升。在所有年份中，男性比女性更容易受到 HFPG 相关心血管疾病的影响。到 2019 年，老年人因高血脂和高血压导致的心血管疾病负担高于年轻人。2019年全球高频气胸导致的心血管疾病负担的主要原因是缺血性心脏病、中风和外周动脉疾病。有必要制定更有针对性的具体策略，以减少高密度脂蛋白血症导致的心血管疾病负担，尤其是男性、老年人和SDI较低的地区。

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引用次数: 0

25(OH)D level and vascular lesion scores in kidney histopathology as risk-stratification tool for predicting renal progression in people with type 2 diabetes 将 25(OH)D 水平和肾组织病理学中的血管病变评分作为预测 2 型糖尿病患者肾脏恶化的风险分级工具。

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103037

Suyan Duan , Fang Lu , Rui Sun , Chen Chen, Si Chen, Luhan Geng, Li Qian, Ying Pan, Chengning Zhang, Ming Zeng, Bin Sun, Huijuan Mao, Bo Zhang , Changying Xing , Yanggang Yuan

Aim

To evaluate the potential of the combined individual vascular histopathological lesion and serum 25-hydroxy vitamin D [25(OH)D] level as predictors of outcomes in patients with diabetes and chronic kidney disease.

Methods

A total of 190 patients with type 2 diabetes and kidney disease stages 1–4 were retrospectively included. Kaplan-Meier analysis and the log-rank test were performed to assess renal survival differences. And the time-dependent receiver operating characteristic analyses were used to characterize the predictive accuracy. Hazard ratios for vascular lesion scores and 25(OH)D levels with renal outcomes were estimated using Cox proportional hazards regression models with follow-up time.

Results

Over a median follow-up of 23.78 (12.61, 37.14) months, 71 patients (37.4 %) experienced the renal outcomes. Enrolled patients with more severe vascular lesions had worse kidney function, heavier proteinuria, lower serum 25(OH)D levels, and higher prevalence of composite kidney outcomes. Baseline serum 25(OH)D was a significant independent risk factor for vascular lesion scores. The effect of serum 25(OH)D level on kidney prognosis was more pronounced in males and those with more exacerbated vascular lesions (score 2). The severity of vascular lesions and serum 25(OH)D levels were associated with unfavorable kidney outcomes. Accordingly, further time-dependent receiver operating characteristic curves confirmed that combined 25(OH)D level and vascular lesion score had a stable and reliable performance in renal outcomes prediction at short and long-term follow-up times.

Conclusions

25(OH)D level and vascular lesion scores in kidney histopathology could serve as a useful risk-stratification tool for predicting renal progression in patients with type 2 diabetes.

目的：评估血管组织病理学病变和血清 25- 羟基维生素 D [25(OH)D]水平作为糖尿病合并慢性肾脏病患者预后预测因子的潜力：回顾性纳入了190名2型糖尿病合并肾病1-4期患者。采用 Kaplan-Meier 分析和对数秩检验评估肾脏存活率差异。并使用时间依赖性接收器操作特征分析来确定预测的准确性。利用随访时间的 Cox 比例危险回归模型估算了血管病变评分和 25(OH)D 水平与肾脏预后的危险比：中位随访时间为 23.78 (12.61, 37.14) 个月，71 名患者（37.4%）出现了肾功能衰竭。血管病变较严重的入组患者肾功能较差、蛋白尿较多、血清25（OH）D水平较低，综合肾脏结果发生率较高。基线血清25（OH）D是血管病变评分的重要独立风险因素。血清 25（OH）D 水平对肾脏预后的影响在男性和血管病变加重（2 级）的人群中更为明显。血管病变的严重程度和血清 25（OH）D 水平与不利的肾脏预后有关。因此，进一步的时间依赖性接收器操作特征曲线证实，在短期和长期随访中，25（OH）D水平和血管病变评分在预测肾脏预后方面具有稳定可靠的表现：结论：肾组织病理学中的25（OH）D水平和血管病变评分可作为预测2型糖尿病患者肾脏恶化的有效风险分级工具。

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引用次数: 0

Association of variabilities in body mass index and waist circumference with newly achieved remission of metabolic dysfunction-associated fatty liver disease 体重指数和腰围的变化与代谢功能障碍相关性脂肪肝新近缓解的关系

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103036

Masahiro Sogabe , Toshiya Okahis , Miwako Kagawa , Motoko Sei , Hiroyuki Ueda , Reiko Yokoyama , Kaizo Kagemoto , Hironori Tanaka , Yoshifumi Kida , Fumika Nakamura , Tetsu Tomonari , Koichi Okamoto , Hiroshi Miyamoto , Yasushi Sato , Masahiko Nakasono , Tetsuji Takayama

Aims

Although body weight reduction is recommended to ameliorate nonalcoholic fatty liver disease, the effects of body mass index (BMI) and waist circumference (WC) variability on newly achieved remission of metabolic dysfunction-associated fatty liver disease (MAFLD) remain unclear. We aimed to investigate the longitudinal association between BMI and WC variabilities and newly achieved MAFLD remission in both sexes.

Methods

Among 26,952 patients, 1823 with MAFLD diagnosed by ultrasonography and with >2 health checkups over >2 years from April 2014 to March 2021 were included in this observational cohort study. A generalized estimation equation model analyzed the association between BMI and WC and newly achieved MAFLD remission according to repeated measures at baseline and the most recent stage.

Results

Rates of MAFLD remission in male and female patients were 7.4 % and 6.0 %, respectively. Regarding decreased BMI variability, newly achieved MAFLD remission prevalence among the subgroups differed significantly between sexes (p < 0.001). In male patients, a decrease in BMI variability of ≥1.5 kg/m² and WC variability of ≥4.2 cm had adjusted odds ratios (ORs) of 5.215 and 2.820, respectively, for newly achieved MAFLD remission. Among female patients, regular exercise and breakfast consumption were accelerating factors for newly achieved MAFLD remission. Non-invasive liver fibrosis scores significantly differed between MAFLD and newly achieved MAFLD remission, including in the subgroups (p < 0.01 and p < 0.001, respectively).

Conclusions

Reducing BMI and WC variabilities in male patients and improving lifestyle habits in female patients may accelerate MAFLD remission.

目的虽然建议减轻体重以改善非酒精性脂肪肝，但体重指数（BMI）和腰围（WC）的变化对代谢功能障碍相关性脂肪肝（MAFLD）新近缓解的影响仍不清楚。方法这项观察性队列研究纳入了26952名患者，其中1823名患者经超声波检查确诊为MAFLD，并在2014年4月至2021年3月的>2年内进行了>2次健康检查。结果男性和女性患者的 MAFLD 缓解率分别为 7.4% 和 6.0%。在 BMI 变异性降低方面，亚组中新获得的 MAFLD 缓解率在性别间存在显著差异（p < 0.001）。在男性患者中，体重指数变异性降低≥1.5 kg/m2和腹围变异性降低≥4.2 cm对新近实现的MAFLD缓解的调整赔率比（ORs）分别为5.215和2.820。在女性患者中，经常锻炼和吃早餐是新近达到 MAFLD 缓解的加速因素。结论降低男性患者的体重指数（BMI）和体重加权平均值（WC）变异，改善女性患者的生活习惯，可加速 MAFLD 的缓解。

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引用次数: 0

Utility of waist-to-height ratio, waist circumference and body mass index in predicting clustered cardiometabolic risk factors and subclinical vascular phenotypes in children and adolescents: A pooled analysis of individual data from 14 countries 腰高比、腰围和体重指数在预测儿童和青少年的心脏代谢风险因素和亚临床血管表型方面的效用：对 14 个国家个人数据的汇总分析

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103042

Xin'nan Zong , Roya Kelishadi , Hae Soon Kim , Peter Schwandt , Tandi E. Matsha , Jose G. Mill , Peter H. Whincup , Lucia Pacifico , Abel López-Bermejo , Carmelo Antonio Caserta , Carla Campos Muniz Medeiros , Wei-Li Yan , Anastasios Kollias , Paula Skidmore , Liane Correia-Costa , A. Khadilkar , Fariborz Sharifian Jazi , Zhuo Gong , Cheng Zhang , Costan G. Magnussen , Bo Xi

Aims

The clinical utility of waist-to-height ratio (WHtR) in predicting cardiometabolic risk factors (CMRFs) and subclinical markers of cardiovascular disease remains controversial. We aimed to compare the utility of WHtR with waist circumference (WC) and body mass index (BMI) in identifying children and adolescents (youths) at risk for cardiometabolic outcomes, including clustered CMRFs, high carotid intima-media thickness (cIMT), and arterial stiffness (assessed as high pulse wave velocity, PWV).

Methods

We analyzed data from 34,224 youths (51.0 % boys, aged 6–18 years) with CMRFs, 5004 (49.5 % boys, aged 6–18 years) with cIMT measurement, and 3100 (56.4 % boys, aged 6–17 years) with PWV measurement from 20 pediatric samples across 14 countries.

Results

WHtR, WC, and BMI z-scores had similar performance in discriminating youths with ≥3 CMRFs, with the area under the curve (AUC) (95 % confidence interval, CI)) ranging from 0.77 (0.75–0.78) to 0.78 (0.76–0.80) using the modified National Cholesterol Education Program (NCEP) definition, and from 0.77 (0.74–0.79) to 0.77 (0.74–0.80) using the International Diabetes Federation (IDF) definition. Similarly, all three measures showed similar performance in discriminating youths with subclinical vascular outcomes, with AUC (95 % CI) ranging from 0.67 (0.64–0.71) to 0.70 (0.66–0.73) for high cIMT (≥P95 values) and from 0.60 (0.58–0.66) to 0.62 (0.58–0.66) for high PWV (≥P95 values).

Conclusions

Our findings suggest that WHtR, WC, and BMI are equally effective in identifying at-risk youths across diverse pediatric populations worldwide. Given its simplicity and ease of use, WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings.

目的腰围身高比（WHtR）在预测心血管代谢风险因素（CMRFs）和心血管疾病亚临床标志物方面的临床实用性仍存在争议。我们的目的是比较 WHtR 与腰围（WC）和体重指数（BMI）在识别儿童和青少年（青少年）心血管代谢结果风险方面的作用，这些风险包括聚集性 CMRFs、高颈动脉内膜中层厚度（cIMT）和动脉僵化（评估为高脉搏波速度，PWV）。我们分析了 34224 名患有 CMRFs 的青少年（51.0% 为男孩，年龄在 6-18 岁之间）、5004 名患有 cIMT 测量的青少年（49.5% 为男孩，年龄在 6-18 岁之间）和 3100 名患有 CMRFs 的青少年（56.4% 为男孩，年龄在 6-17 岁之间）的数据。结果WHtR、WC 和 BMI z 评分在区分 CMRFs≥3 的青少年方面表现相似，曲线下面积（AUC）（95 % 置信区间，CI）范围为 0.采用修改后的美国国家胆固醇教育计划（NCEP）定义，曲线下面积（AUC）从 0.77（0.75-0.78）到 0.78（0.76-0.80）不等；采用国际糖尿病联盟（IDF）定义，曲线下面积（AUC）从 0.77（0.74-0.79）到 0.77（0.74-0.80）不等。同样，所有三种测量方法在鉴别亚临床血管结局的青少年方面表现相似，高 cIMT（≥P95 值）的 AUC（95 % CI）从 0.67（0.64-0.71）到 0.70（0.66-0.73）不等，而高 cIMT（≥P95 值）的 AUC（95 % CI）从 0.结论我们的研究结果表明，在全球不同的儿科人群中，WHtR、WC 和 BMI 对于识别高危青少年同样有效。鉴于 WHtR 简单易用，它可以成为在临床环境中快速筛查心脏代谢风险增加的青少年的首选。

{"title":"Utility of waist-to-height ratio, waist circumference and body mass index in predicting clustered cardiometabolic risk factors and subclinical vascular phenotypes in children and adolescents: A pooled analysis of individual data from 14 countries","authors":"Xin'nan Zong , Roya Kelishadi , Hae Soon Kim , Peter Schwandt , Tandi E. Matsha , Jose G. Mill , Peter H. Whincup , Lucia Pacifico , Abel López-Bermejo , Carmelo Antonio Caserta , Carla Campos Muniz Medeiros , Wei-Li Yan , Anastasios Kollias , Paula Skidmore , Liane Correia-Costa , A. Khadilkar , Fariborz Sharifian Jazi , Zhuo Gong , Cheng Zhang , Costan G. Magnussen , Bo Xi","doi":"10.1016/j.dsx.2024.103042","DOIUrl":"10.1016/j.dsx.2024.103042","url":null,"abstract":"<div><h3>Aims</h3><p>The clinical utility of waist-to-height ratio (WHtR) in predicting cardiometabolic risk factors (CMRFs) and subclinical markers of cardiovascular disease remains controversial. We aimed to compare the utility of WHtR with waist circumference (WC) and body mass index (BMI) in identifying children and adolescents (youths) at risk for cardiometabolic outcomes, including clustered CMRFs, high carotid intima-media thickness (cIMT), and arterial stiffness (assessed as high pulse wave velocity, PWV).</p></div><div><h3>Methods</h3><p>We analyzed data from 34,224 youths (51.0 % boys, aged 6–18 years) with CMRFs, 5004 (49.5 % boys, aged 6–18 years) with cIMT measurement, and 3100 (56.4 % boys, aged 6–17 years) with PWV measurement from 20 pediatric samples across 14 countries.</p></div><div><h3>Results</h3><p>WHtR, WC, and BMI z-scores had similar performance in discriminating youths with ≥3 CMRFs, with the area under the curve (AUC) (95 % confidence interval, CI)) ranging from 0.77 (0.75–0.78) to 0.78 (0.76–0.80) using the modified National Cholesterol Education Program (NCEP) definition, and from 0.77 (0.74–0.79) to 0.77 (0.74–0.80) using the International Diabetes Federation (IDF) definition. Similarly, all three measures showed similar performance in discriminating youths with subclinical vascular outcomes, with AUC (95 % CI) ranging from 0.67 (0.64–0.71) to 0.70 (0.66–0.73) for high cIMT (≥P95 values) and from 0.60 (0.58–0.66) to 0.62 (0.58–0.66) for high PWV (≥P95 values).</p></div><div><h3>Conclusions</h3><p>Our findings suggest that WHtR, WC, and BMI are equally effective in identifying at-risk youths across diverse pediatric populations worldwide. Given its simplicity and ease of use, WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings.</p></div>","PeriodicalId":48252,"journal":{"name":"Diabetes & Metabolic Syndrome-Clinical Research & Reviews","volume":null,"pages":null},"PeriodicalIF":10.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk assessment of diabetes using the Indian Diabetes Risk Score among older adults: Secondary analysis from the Longitudinal Ageing Study in India 使用印度糖尿病风险评分对老年人进行糖尿病风险评估：印度老龄化纵向研究的二次分析。

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103040

Saurav Basu , Vansh Maheshwari , Debolina Roy , Mahira Saiyed , Rutul Gokalani

Background

The Indian Diabetes Risk Score (IDRS) is a simple tool to assess the probability of an individual having type 2 diabetes (T2DM) but its applicability in community-dwelling older adults is lacking. This study aimed to estimate the risk of T2DM and its determinants among older adults without prior diabetes (DM) using the IDRS, while also assessing its sensitivity and specificity in individuals with a history of diabetes.

Methods

We analyzed cross-sectional data from the Longitudinal Ageing Study in India (LASI) wave-1 (2017-18). IDRS was calculated amongst individuals aged ≥45 years considering waist circumference, physical activity, age and family history of DM. Risk was categorized as high (≥60), moderate (30–50), and low (<30).

Results

Among 64541 individuals, 7.27 % (95 % CI: 6.78, 7.80) were at low risk, 61.80 % (95 % CI: 60.99, 62.61) at moderate risk, and 30.93 % (95 % CI: 30.19, 31.67) at high risk for T2DM. Adjusted analysis showed higher risk of T2DM among men, widowed/divorced, urban residents, minority religions, overweight, obese, and individuals with hypertension. ROC curve yielded an AUC of 0.67 (95 % CI: 0.66, 0.67, P < 0.001). The IDRS cutoff ≥50 had 73.69 % sensitivity and 51.40 % specificity for T2DM detection.

Conclusion

More than 9 in 10 older adults in India without history of DM have high-moderate risk of T2DM when assessed with the IDRS risk-prediction tool. However, the low specificity and moderate sensitivity of IDRS in existing DM cases constraints its practical utility as a decision tool for screening.

背景：印度糖尿病风险评分（IDRS）是一种评估个人患 2 型糖尿病（T2DM）概率的简单工具，但其在社区居住的老年人中的适用性还很欠缺。本研究旨在使用印度糖尿病评分法估算无糖尿病史的老年人患 T2DM 的风险及其决定因素，同时评估该评分法对有糖尿病史者的敏感性和特异性：我们分析了印度纵向老龄化研究（LASI）第 1 波（2017-18 年）的横截面数据。考虑到腰围、体力活动、年龄和糖尿病家族史，对年龄≥45岁的个体计算了IDRS。风险分为高风险（≥60）、中度风险（30-50）和低风险（结果：在 64541 人中，7.27%（95 % CI：6.78, 7.80）为低风险，61.80%（95 % CI：60.99, 62.61）为中度风险，30.93%（95 % CI：30.19, 31.67）为 T2DM 高风险。调整后的分析表明，男性、丧偶/离异、城市居民、信仰少数宗教、超重、肥胖和高血压患者患 T2DM 的风险较高。ROC 曲线的 AUC 为 0.67（95 % CI：0.66, 0.67，P 结论：使用 IDRS 风险预测工具进行评估时，印度每 10 位无糖尿病史的老年人中就有 9 位以上具有 T2DM 的中高风险。然而，IDRS 对现有 DM 病例的特异性较低，灵敏度适中，这限制了其作为筛查决策工具的实用性。

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引用次数: 0

Impact of sarcopenic obesity on heart failure in people with type 2 diabetes and the role of metabolism and inflammation: A prospective cohort study 肌肉疏松性肥胖对 2 型糖尿病患者心力衰竭的影响以及新陈代谢和炎症的作用：前瞻性队列研究。

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103038

Xueqing Jia , Liming Zhang , Zhenqing Yang , Xingqi Cao , Zhao Yao , Jingyun Zhang , Zuobing Chen , Zuyun Liu

Aims

We aimed to prospectively evaluate the association of sarcopenic obesity (SO) with the incidence risk of heart failure (HF), and the mediating role of metabolomics and inflammation in people with type 2 diabetes (T2D).

Methods

22,496 participants with T2D from the UK Biobank were included. SO was defined as the combination of obesity (body mass index ≥30 kg/m²) and sarcopenia (grip strength <27 kg in male or <16 kg in female). The incident HF was identified through linked hospital records. Cox proportional hazard regression models were used to estimate the associations. Mediation analysis was conducted to evaluate the mediating effect of the “metabolomic risk score” of HF, which was derived from 168 plasma metabolites through LASSO regression, and five inflammatory markers (e.g., C-reactive protein [CRP] level) on the aforementioned associations.

Results

1946 (8.7 %) participants developed HF during a median follow-up of 12.0 years. Compared to participants with neither obesity nor sarcopenia, those with obesity & non-sarcopenia (hazard ratio [HR]: 1.80, 95 % confidence interval [CI]: 1.62, 2.00), sarcopenia & non-obesity (HR: 1.90, 95 % CI: 1.56, 2.31) and SO (HR: 2.29, 95 % CI: 1.92, 2.73) showed a higher risk of HF. The metabolomic risk score (20.0 %) and CRP (20.4 %) meditated this association.

Conclusions

SO was associated with an increased risk of HF in people with T2D and metabolomics and inflammation partially mediated this association. Our findings suggest the importance of managing obesity and muscle strength simultaneously in preventing HF among people with T2D and shed light on the underlying mechanisms.

目的：我们旨在前瞻性地评估肌肉疏松性肥胖（SO）与心力衰竭（HF）发病风险的关系，以及代谢组学和炎症在2型糖尿病（T2D）患者中的中介作用。SO定义为肥胖（体重指数≥30 kg/m2）和肌少症（握力）的组合：1946名参与者（8.7%）在12.0年的中位随访期间患上了心房颤动。与既无肥胖症也无肌肉疏松症的参与者相比，肥胖症和非肌肉疏松症（危险比[HR]：1.80，95% 置信区间[CI]：1.62, 2.00）、肌肉疏松症和非肥胖症（HR：1.90，95% 置信区间[CI]：1.56, 2.31）和肥胖症（HR：2.29，95% 置信区间[CI]：1.92, 2.73）患者患心房颤动的风险更高。代谢组风险评分（20.0%）和 CRP（20.4%）对这种关联起到了中介作用：结论：肥胖与 T2D 患者罹患心房颤动的风险增加有关，代谢组学和炎症在一定程度上介导了这种关联。我们的研究结果表明，同时控制肥胖和肌肉力量对预防 T2D 患者的房颤非常重要，并揭示了其潜在机制。

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引用次数: 0

Graves’ disease and the risk of five autoimmune diseases: A Mendelian randomization and colocalization study 巴塞杜氏病与五种自身免疫性疾病的风险：孟德尔随机化和共聚焦研究

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103023

Tao Su , Ying Gan , Shulin Ma , Hongzhen Wu , Shilin Lu , Min Zhi , Bao Wang , Yi Lu , Jiayin Yao

Background

Epidemiological studies have consistently demonstrated a high prevalence of concurrent autoimmune diseases in individuals with Graves' disease (GD).

Objective

The objective of this study is to establish a causal association between GD and autoimmune diseases.

Methods

We employed a two-sample Mendelian randomization (MR) to infer a causal association between GD and five autoimmune diseases, namely rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), Crohn's disease (CD), ulcerative colitis (UC), and amyotrophic lateral sclerosis (ALS), in the East Asian and European population. Genetic correlations were explored through linkage disequilibrium score regression analysis (LDSC). Finally, colocalization analyses were performed to investigate possible genetic foundations.

Results

Bidirectional MR analysis indicated that genetically predicted GD increased the risk of RA (Odds Ratio (OR): 1.34, 95 % Confidence Interval (CI): 1.21 to 1.47, P < 0.001) and SLE (OR: 1.21, 95%CI: 1.08 to 1.35, P < 0.001) in the East Asian population. In contrast, we found that genetically predicted RA (OR: 1.14, 95%CI: 1.05 to 1.24, P = 0.002) and SLE (OR: 1.10, 95%CI: 1.03 to 1.17, P = 0.003) were associated with a higher risk of GD. The results have been partially validated in European cohorts. Colocalization analysis suggested the potential existence of shared causal variants between GD and other autoimmune diseases. In particular, gene ARID5B may play an important role in the incidence of autoimmune diseases.

Conclusion

This study has confirmed that GD was associated with RA and SLE and found a possible key gene ARID5B. It may be necessary to strengthen detection to prevent the occurrence of comorbidities in clinical practice.

背景流行病学研究一致表明，巴塞杜氏病（GD）患者并发自身免疫性疾病的发病率很高。方法我们采用双样本孟德尔随机法（MR），在东亚和欧洲人群中推断出巴塞杜氏病与五种自身免疫性疾病（即类风湿性关节炎（RA）、系统性红斑狼疮（SLE）、克罗恩病（CD）、溃疡性结肠炎（UC）和肌萎缩性脊髓侧索硬化症（ALS））之间的因果关系。通过连锁不平衡评分回归分析（LDSC）探讨了遗传相关性。结果双向 MR 分析表明，在东亚人群中，遗传预测的 GD 会增加患 RA（Odds Ratio (OR)：1.34，95% Confidence Interval (CI)：1.21 至 1.47，P < 0.001）和系统性红斑狼疮（OR：1.21，95%CI：1.08 至 1.35，P < 0.001）的风险。相比之下，我们发现遗传预测的 RA（OR：1.14，95%CI：1.05 至 1.24，P = 0.002）和系统性红斑狼疮（OR：1.10，95%CI：1.03 至 1.17，P = 0.003）与较高的 GD 风险相关。这些结果在欧洲队列中得到了部分验证。共定位分析表明，GD 与其他自身免疫性疾病之间可能存在共同的因果变异。结论这项研究证实了 GD 与 RA 和系统性红斑狼疮有关，并发现了一个可能的关键基因 ARID5B。本研究证实了 GD 与 RA 和系统性红斑狼疮相关，并发现了可能的关键基因 ARID5B，因此有必要在临床实践中加强检测，以防止合并症的发生。

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引用次数: 0

Intrahepatic hypothyroidism in MASLD: Role of liver-specific thyromimetics including resmetirom 肝内甲状腺功能减退症（MASLD）：包括瑞美替罗在内的肝脏特异性甲状腺激素类药物的作用

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103034

Mohammad Shafi Kuchay , Scott Isaacs , Anoop Misra

Background and aims

Thyroid hormones are important regulators of hepatic lipid homeostasis and whole-body energy expenditure. Recent evidence suggests that euthyroid individuals with metabolic dysfunction-associated steatohepatitis (MASH) develop intrahepatic hypothyroidism that promotes progression of MASH.

Methods

A literature search was performed with Medline (PubMed), Scopus and Google Scholar electronic databases from inception till March 2024, using the following keywords: hypothyroidism and nonalcoholic fatty liver disease; MASLD and thyroid function; intrahepatic hypothyroidism; TRβ agonists; and resmetirom. Relevant studies were extracted that described pathogenesis of MASH in the context of thyroid functions.

Results

In euthyroid individuals with MASH, there is decreased conversion of prohormone thyroxine (T4) to bioactive tri-iodothyronine (T3) and increased conversion of T4 to inactive metabolite reverse T3 (rT3). Consequently, reduced levels of T3 results in impaired intrahepatic TRβ signaling, a state of intrahepatic hypothyroidism, which promotes progression of MASH. Hepatic TRβ activation leads to metabolically beneficial effects in the liver including mitochondrial fatty acid uptake and β-oxidation, mitochondrial biogenesis, increasing surface low-density lipoprotein (LDL) receptor density and lowering of circulatory LDL-cholesterol. In recent years, selective thyroid hormone mimetics that exhibit TRβ-selective binding and liver-selective uptake have been designed. Resmetirom, a liver-specific thyromimetic, improves intrahepatic TRβ signaling and in clinical trials significantly improved liver inflammation, fibrosis and lipid profile in patients with MASH.

Conclusions

In euthyroid individuals with MASH, development of intrahepatic hypothyroidism results in further progression of the disease. In clinical trials, resmetirom treatment results in a significant improvement in steatosis, inflammation and fibrosis and is the first drug approved by the US Food and Drug Administration (FDA) for the treatment of noncirrhotic MASH with moderate to advanced fibrosis.

背景和目的甲状腺激素是肝脏脂质平衡和全身能量消耗的重要调节因子。最近的证据表明，患有代谢功能障碍相关性脂肪性肝炎（MASH）的甲状腺功能正常者会出现肝内甲状腺功能减退，从而促进MASH的进展。方法使用以下关键词在Medline（PubMed）、Scopus和Google Scholar电子数据库中进行文献检索：甲状腺功能减退与非酒精性脂肪肝；MASLD与甲状腺功能；肝内甲状腺功能减退；TRβ激动剂；雷美替罗。结果在甲状腺功能正常的 MASH 患者中，原甲状腺素（T4）向生物活性三碘甲状腺原氨酸（T3）的转化减少，而 T4 向非活性代谢产物反向 T3（rT3）的转化增加。因此，T3水平的降低会导致肝内TRβ信号传导受损，形成肝内甲状腺功能减退症，从而促进MASH的发展。肝脏 TRβ 激活会导致肝脏产生有益的代谢作用，包括线粒体脂肪酸摄取和 β 氧化、线粒体生物生成、增加表面低密度脂蛋白（LDL）受体密度和降低循环中的低密度脂蛋白胆固醇。近年来，人们设计出了具有 TRβ 选择性结合和肝脏选择性吸收的选择性甲状腺激素模拟物。雷美替罗是一种肝脏特异性甲状腺激素模拟物，可改善肝内TRβ信号传导，在临床试验中可显著改善MASH患者的肝脏炎症、纤维化和血脂状况。在临床试验中，雷美替罗治疗可明显改善脂肪变性、炎症和纤维化，是美国食品药品管理局（FDA）批准用于治疗非肝硬化MASH中晚期纤维化的首个药物。

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引用次数: 0

Intensive or liberal glucose control in intensive care units for septic patients? A meta-analysis of randomized controlled trials 在重症监护病房对脓毒症患者进行强化还是宽松的血糖控制？随机对照试验荟萃分析

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103045

Jiahao Meng , Xi Li , Yifan Xiao , Hang Tang , Pan Liu , Yumei Wu , Yilin Xiong , Shuguang Gao

Objective

To compare the clinical outcomes of intensive glucose control and liberal glucose control for septic patients in intensive care unit.

Methods

The databases of PubMed, Cochrane Library, Embase and Web of Science were searched systematically from inception to November 27, 2023 to identify trials involving a randomized comparison between intensive and liberal glucose control for septic patients in intensive care unit.

Results

A total of 14 randomized controlled trials involving 6226 patients were finally included. There was no statistically significant difference observed between intensive glucose control and liberal glucose control in terms of all-cause mortality, the need for renal replacement, vasopressor-free and mechanical ventilation-free days, and length of hospital stay. However, it is noteworthy that intensive glucose control exhibited a statistically higher risk of severe hypoglycemia (RR 2.66; 95%CI 1.85 to 3.83), need for blood transfusion (RR 1.12; 95%CI 1.01 to 1.23), and statistically prolonged length of stay in the ICU (MD 1.67; 95%CI 0.22 to 3.12) compared to liberal glucose control. Nevertheless, sensitivity analysis revealed that the need for blood transfusion and length of stay in the intensive care unit were not robust.

Conclusions

Both intensive and liberal glucose control had comparable effects on improving patient outcomes, but intensive glucose control carried a higher risk of severe hypoglycemia.

方法对 PubMed、Cochrane Library、Embase 和 Web of Science 等数据库从开始到 2023 年 11 月 27 日进行了系统检索，以确定对重症监护病房脓毒症患者进行强化葡萄糖控制和自由葡萄糖控制的随机比较试验。在全因死亡率、肾脏替代需求、无血管加压和无机械通气天数以及住院时间方面，强化葡萄糖控制与宽松葡萄糖控制之间没有统计学意义上的显著差异。然而，值得注意的是，与宽松的血糖控制相比，强化血糖控制发生严重低血糖（RR 2.66；95%CI 1.85 至 3.83）、需要输血（RR 1.12；95%CI 1.01 至 1.23）和在重症监护室住院时间延长（MD 1.67；95%CI 0.22 至 3.12）的风险更高。尽管如此，敏感性分析表明输血需求和重症监护室住院时间并不稳定。结论强化血糖控制和自由血糖控制对改善患者预后的效果相当，但强化血糖控制发生严重低血糖的风险更高。

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引用次数: 0

Prevention of diabetes from prediabetes in real world setting in South India 在南印度的现实环境中，从糖尿病前期预防糖尿病。

IF 1 Q1 Medicine

Diabetes & Metabolic Syndrome-Clinical Research & Reviews

Pub Date : 2024-05-01 DOI: 10.1016/j.dsx.2024.103041

Vijay Viswanathan, Premalatha Murugan, Satyavani Kumpatla, Rizwana Parveen, Arutselvi Devarajan

Aim

The aim was to explore the effect of lifestyle modification in a real world situation to prevent the progression to diabetes in India.

Methods

Participants who underwent OGTT from August 2017–2022 and were diagnosed as having Prediabetes (n = 200) were assigned into control (group1, n = 100) received standard care and intervention (group2, n = 100) received intensive counseling on physical activity (PA) and diet. PA included walking for 150 min/week and personalized advice based on the profession. OGTTs were repeated once every 6 months for 5 years and primary outcome was development of DM.

Results

The conversion rate was significantly higher in the control group than the intervention group (44.6 vs.7.9 %, p < 0.0001). Individuals who reverted back to normal was significantly higher in Group2 compared to Group1 (34.9 vs.6.2 %; p < 0.001). A significant increase in weight, BMI and waist circumference in group1 and significant reduction in glucose and HbA1c was noted in group2. Mean (95%CI) survival time for Group1 was 25.4 (20.8–29.9) and Group2 was 36.4months (32.6–40.1; p < 0.001). The factors which influenced the conversion of prediabetes to DM were averaged BMI, fasting and 2hr glucose levels of all follow up visit measurements.

Conclusion

We can prevent diabetes in individuals with prediabetes using real world strategies in India.

方法将 2017 年 8 月至 2022 年期间接受 OGTT 并被诊断为糖尿病前期的参与者（n = 200）分为对照组（第 1 组，n = 100）和干预组（第 2 组，n = 100），对照组接受标准护理，干预组接受体育锻炼（PA）和饮食方面的强化咨询。体力活动包括每周步行 150 分钟，并根据专业提供个性化建议。结果对照组的转阴率明显高于干预组（44.6% 对 7.9%，P < 0.0001）。与第一组相比，第二组恢复正常的人数明显较多（34.9% 对 6.2%；p <0.001）。第一组的体重、体重指数和腰围明显增加，第二组的血糖和 HbA1c 明显降低。第一组的平均（95%CI）存活时间为 25.4 个月（20.8-29.9），第二组为 36.4 个月（32.6-40.1；p < 0.001）。影响糖尿病前期转化为糖尿病的因素是所有随访测量的平均体重指数、空腹血糖和 2 小时血糖水平。

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引用次数: 0